Clinical features and risk factors associated with severe COVID-19 patients in China / 中华医学杂志(英文版)

BACKGROUND@#Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread throughout the world. In this study, we aimed to identify the risk factors for severe COVID-19 to improve treatment guidelines.@*METHODS@#A multicenter, cross-sectional study was conducted on 313 patients hospitalized with COVID-19. Patients were classified into two groups based on disease severity (nonsevere and severe) according to initial clinical presentation. Laboratory test results and epidemiological and clinical characteristics were analyzed using descriptive statistics. Univariate and multivariate logistic regression models were used to detect potential risk factors associated with severe COVID-19.@*RESULTS@#A total of 289 patients (197 nonsevere and 92 severe cases) with a median age of 45.0 (33.0, 61.0) years were included in this study, and 53.3% (154/289) were male. Fever (192/286, 67.1%) and cough (170/289, 58.8%) were commonly observed, followed by sore throat (49/289, 17.0%). Multivariate logistic regression analysis suggested that patients who were aged ≥ 65 years (OR: 2.725, 95% confidence interval [CI]: 1.317-5.636; P = 0.007), were male (OR: 1.878, 95% CI: 1.002-3.520, P = 0.049), had comorbid diabetes (OR: 3.314, 95% CI: 1.126-9.758, P = 0.030), cough (OR: 3.427, 95% CI: 1.752-6.706, P < 0.001), and/or diarrhea (OR: 2.629, 95% CI: 1.109-6.231, P = 0.028) on admission had a higher risk of severe disease. Moreover, stratification analysis indicated that male patients with diabetes were more likely to have severe COVID-19 (71.4% vs. 28.6%, χ2 = 8.183, P = 0.004).@*CONCLUSIONS@#The clinical characteristics of those with severe and nonsevere COVID-19 were significantly different. The elderly, male patients with COVID-19, diabetes, and presenting with cough and/or diarrhea on admission may require close monitoring to prevent deterioration.

A Risk Prediction Model for Cardiac Rehabilitation in Patients with Stable Coronary Artery Disease / 中国康复理论与实践

Objective:To create a prediction model that could be used to stratify the risk of cardiac rehabilitation in patients with stable coronary artery disease by using test data based on cardiopulmonary exercise testing (CPET) and general clinical data. Methods:A total of 114 patients with stable coronary artery disease were consecutively enrolled from the Cardiology Coronary Artery Disease Database of our hospital from December, 2014 to December, 2018, all the patients underwent CPET before coronary angiography. LASSO was used for feature selection. A nomogram was formulated based on the results of multivariate Logistic regression analysis using the RMS package of R. The predictive power was assessed with Receiver Operating Characteristic Curve. Results:Seven predictors were identified based on LASSO: coronary angiography results, the maximum value of ventilatory equivalent for carbon dioxide (EqCO2max), lymphocyte count, fasting blood glucose levels, cardiac muscle enzyme positivity, blood homocysteine and blood urea nitrogen levels. Combined with clinical experience and weighting analysis, the final four factors were included for Logistic regression modeling: coronary angiography results, EqCO2max, lymphocyte count and fasting blood glucose levels. The area under the curve was 0.875 for the model. Conclusion:EqCO2max and lymphocyte count are key predictors for stable coronary heart disease and can be used to identify patients at high risk for cardiac rehabilitation. A risk stratification model based on CPET and laboratory tests can be used to assess risk stratification for cardiac rehabilitation in patients with stable coronary artery disease.

Usage of ethnomedicine on COVID-19 in China / 中国中药杂志

In December 2019, an outbreak of viral pneumonia began in Wuhan, Hubei Province, which caused the spread of infectious pneumonia to a certain extent in China and neighboring countries and regions, and triggered the epidemic crisis. The coronavirus disease 2019(COVID-19) is an acute respiratory infectious disease listed as a B infectious disease, which is managed according to standards for A infectious disease. Traditional Chinese medicine and integrated traditional Chinese and Western medicine have played an active role in the prevention and control of this epidemic. China's ethnomedicine has recognized infectious diseases since ancient times, and formed a medical system including theory, therapies, formula and herbal medicines for such diseases. Since the outbreak of the COVID-19 epidemic, Tibet Autonomous Region, Qinghai Province, Inner Mongolia Autonomous Region, Xinjiang Uygur Autonomous Region and Chuxiong Autonomous Prefecture of Yunnan, Qiandongnan Autonomous Prefecture of Guizhou have issued the prevention and control programs for COVID-19 using Tibetan, Mongolian, Uygur, Yi and Miao medicines. These programs reflect the wisdom of ethnomedicine in preventing and treating diseases, which have successfully extracted prescriptions and preventive measures for the outbreak of the epidemic from their own medical theories and traditional experiences. In this paper, we summarized and explained the prescriptions and medicinal materials of ethnomedicine in these programs, and the origin of Tibetan medicine prescriptions and Mongolian medicine prescriptions in ancient books were studied. These become the common characteristics of medical prevention and treatment programs for ethnomedicine to formulate therapeutic programs under the guidance of traditional medicine theories, recommend prescriptions and prevention and treatment methods with characteristics of ethnomedicine, and focus on the conve-nience and standardization. However, strengthening the support of science and technology and the popularization to the public, and improving the participation of ethnomedicine in national public health services and the capacity-building to deal with sudden and critical diseases are key contents in the development of ethnomedicine in the future.

Radiological features of traumatic vertebral endplate fracture: an analysis of 194 cases with 263 vertebral fractures / 中华医学杂志(英文版)

BACKGROUND@#The importance of identifying osteoporotic vertebral endplate or/and cortex fracture (ECF), which primarily includes endplate fracture (EPF) and vertebral anterior cortex buckling, has been recognized. However, some old traumatic ECFs with healing process in the elderly may be mistaken as osteoporotic. This study analyzes the radiological features of traumatic EPF.@*METHODS@#This was a retrospective analysis of 194 spine trauma patients with 263 vertebral fractures (mean age: 42.11 ± 9.82 years, 118 males and 76 females). All patients had traumatic EPF identified by X-ray/CT/MRI.@*RESULTS@#The involved vertebra was mostly L1 (29.7%), followed by T12 and L2. Except EPFs involved both superior and inferior endplates (12.6%), only 1.9% involved inferior endplate alone, with the majority involved superior endplate. If each endplate was divided into five segments of equal lengths (from anterior to posterior: a1, a2, m, p2, p1), the most depressed point of superior EPFs was mostly at segment-a2 (approximately 45%), followed by segment-a1 (approximately 20%) or segment-m (approximately 20%), and very rarely at segment-p1. The upper 1/3 of anterior vertebral wall was more likely to fracture, followed by middle 1/3 of anterior wall. For posterior vertebral wall fracture, 68.5% broke the bony wall surrounding the basivertebral vain. 58.6%, 30.0%, and 11.4% of vertebral fractures had 1/3 vertebral body height loss. As the extent of vertebral height loss increased, the chance of having both superior and inferior EPFs also increased; however, the chance of having inferior EPF alone did not increase.@*CONCLUSION@#Traumatic EPF features are characterized, which may help the differentiation of traumatic and osteoporotic EPFs.

Time-dependent Changes of Blood Pressure in Cardiopulmonary Exercise Test for Females with Hypertension / 中国康复理论与实践

Objective:To explore the time-dependent changes of blood pressure with the increase of exercise intensity and its clinical significance in Cardiopulmonary Exercise Test for female patients with hypertension. Methods:From August, 2018 to August, 2019, 64 patients (hypertension group) who did not take β-receptor blockers and dihydropyridine calcium antagonists were selected from grade 1 and grade 2 hypertension women excluding myocardial ischemia with Cardiopulmonary Exercise Test. And 86 healthy women (non-hypertension group) excluding myocardial ischemia from the same period of Cardiopulmonary Exercise Test were selected as the controls for retrospective analysis. The time-dependent changes of blood pressure with the increase of exercise intensity were compared between two groups. Results:The blood pressures at resting for three minutes, anaerobic threshold and peak were significantly higher in the hypertension group than in the non-hypertension group (Z > 3.306, P < 0.001). There was no significant difference in peak oxygen uptake between two groups (Z = 1.549, P > 0.05). Conclusion:The blood pressure of the patients with grade 1 and grade 2 hypertension is prone to over elevation, who should pay more attention on blood pressure in sports and rehabilitation.

Spreading of extended-spectrum β-lactamase-producing Escherichia coli ST131 and Klebsiella pneumoniae ST11 in patients with pneumonia: a molecular epidemiological study / 中华医学杂志(英文版)

Background@#Extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) are the important pathogens causing pneumonia. This study aimed to investigate the clinical characteristics and molecular epidemiology of ESBL-producing E. coli and K. pneumoniae causing pneumonia at a large teaching hospital in China.@*Methods@#We collected patient’s clinical data and ESBL-producing E. coli and K. pneumoniae strains causing pneumonia (from December 2015 to June 2016) at a hospital in Wuhan. The susceptibilities, multi-locus sequence typing, homologous analysis, ESBL genes by polymerase chain reaction and sequencing were determined.@*Results@#A total of 59 ESBL-producing strains (31 E. coli and 28 K. pneumoniae) isolated from patients with pneumonia were analyzed. The majority of strains were isolated from patients were with hospital-acquired pneumonia (37/59, 62.7%), followed by community-acquired pneumonia (13/59, 22.0%), and ventilator-related pneumonia (9/59, 15.3%). The E. coli ST131 (9 isolates, 29.0%) and K. pneumoniae ST11 (5 isolates, 17.9%) were the predominant sub-types. The most prevalent ESBL gene was CTX-M-14, followed by SHV-77, CTX-M-3, SHV-11, and CTX-M-27. At least 33 (55.9%) of the ESBL-producing strains carried two or more ESBL genes. The ISEcp1 and IS26 were found upstream of all blaCTX-M (CTX-Ms) and of most blaSHV (SHVs) (57.6%), respectively. Moreover, three ESBL-producing K. pneumoniae ST11 strains which were resistant to carbapenems carried the blaNDM-1 and blaKPC-2, two of which also bearing blaOXA-48 were resistant to all antibiotics (including Tigecycline).@*Conclusions@#Hospital-acquired pneumonia is more likely correlated with ESBL-producing E. coli and K. pneumoniae. ESBL-producing E. coli ST131 and multi-drug resistance ESBL-producing, as well as New Delhi metallo-β-lactamase-1 (NDM-1) and Klebsiella pneumoniae carbapenemases-2 (KPC-2) bearing K. pneumoniae ST11 are spreading in patients with pneumonia in hospital.

Spreading of extended-spectrum β-lactamase-producing Escherichia coli ST131 and Klebsiella pneumoniae ST11 in patients with pneumonia: a molecular epidemiological study / 中华医学杂志(英文版)

BACKGROUND@#Extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) are the important pathogens causing pneumonia. This study aimed to investigate the clinical characteristics and molecular epidemiology of ESBL-producing E. coli and K. pneumoniae causing pneumonia at a large teaching hospital in China.@*METHODS@#We collected patient's clinical data and ESBL-producing E. coli and K. pneumoniae strains causing pneumonia (from December 2015 to June 2016) at a hospital in Wuhan. The susceptibilities, multi-locus sequence typing, homologous analysis, ESBL genes by polymerase chain reaction and sequencing were determined.@*RESULTS@#A total of 59 ESBL-producing strains (31 E. coli and 28 K. pneumoniae) isolated from patients with pneumonia were analyzed. The majority of strains were isolated from patients were with hospital-acquired pneumonia (37/59, 62.7%), followed by community-acquired pneumonia (13/59, 22.0%), and ventilator-related pneumonia (9/59, 15.3%). The E. coli ST131 (9 isolates, 29.0%) and K. pneumoniae ST11 (5 isolates, 17.9%) were the predominant sub-types. The most prevalent ESBL gene was CTX-M-14, followed by SHV-77, CTX-M-3, SHV-11, and CTX-M-27. At least 33 (55.9%) of the ESBL-producing strains carried two or more ESBL genes. The ISEcp1 and IS26 were found upstream of all blaCTX-M (CTX-Ms) and of most blaSHV (SHVs) (57.6%), respectively. Moreover, three ESBL-producing K. pneumoniae ST11 strains which were resistant to carbapenems carried the blaNDM-1 and blaKPC-2, two of which also bearing blaOXA-48 were resistant to all antibiotics (including Tigecycline).@*CONCLUSIONS@#Hospital-acquired pneumonia is more likely correlated with ESBL-producing E. coli and K. pneumoniae. ESBL-producing E. coli ST131 and multi-drug resistance ESBL-producing, as well as New Delhi metallo-β-lactamase-1 (NDM-1) and Klebsiella pneumoniae carbapenemases-2 (KPC-2) bearing K. pneumoniae ST11 are spreading in patients with pneumonia in hospital.

Regional Differences of the Urinary Proteomes in Healthy Chinese Individuals / 中国医学科学杂志(英文版)

Objective Urine is a promising biomarker source for clinical proteomics studies. Regional physiological differences are common in multi-center clinical studies. In this study, we investigate whether significant differences are present in the urinary proteomes of individuals from different regions in China. Methods In this study, morning urine samples were collected from healthy urban residents in three regions of China (Haikou, Xi'an and Xining) and urinary proteins were preserved using a membrane-based method (Urimem). The urine proteomes of 27 normal samples were analyzed using LC-MS/MS and compared among three regions. Functional annotation of the differential proteins among the three areas was analyzed using the DAVID online database, and pathway enrichment of the differential urinary proteins was analyzed using KEGG. Results We identified 1898 proteins from Urimem samples using label-free proteome quantification, of which 56 urine proteins were differentially expressed among the three regions ( < 0.05). Hierarchical clustering analysis showed that inter-regional differences caused less significant changes in the urine proteome than inter-sex differences. After gender stratification, 16 differential proteins were identified in male samples and 84 differential proteins were identified in female samples. Among these differential proteins, several proteins have been previously reported as urinary disease biomarkers. Conclusions Urimem will facilitate urinary protein storage for large-scale urine sample collection. Regional differences are a confounding factor influencing the urine proteome and should be considered in future multi-center biomarker studies.

Analysis of efficacy and safety of operation in treating secondary glaucoma caused by contusion hyphema / 国际眼科杂志(Guoji Yanke Zazhi)

?AIM:To explore the efficacy and safety of operation in treating secondary glaucoma caused by contusion hyphema.?METHODS: Seventy patients (70 eyes) with secondary glaucoma caused by contusion of anterior chamber in our hospital from November 2014 to November 2015 were selected.All patients were treated by operation.Visual acuity, anterior chamber depth, mean intraocular pressure and postoperative complications of patients before and after operation were compared.?RESULTS:Patients with secondary glaucoma caused by contusion of anterior chamber had better visual acuity after operation and the difference was statistically significant (t=42.471, P<0.001).And they had deeper anterior chamber depth and lower mean intraocular pressure, and the differences were statistically significant (t=9.726, 26.041; P<0.001).Two of those patients had emergence of hyphema after operation and symptomatic relieved after treatment. None of the patients had complications such as blood-staining of cornea or eye pain.? CONCLUSION: The curative effect of operation in treating secondary glaucoma caused by contusion of anterior chamber is good and safe and it can improve visual acuity, deepen the anterior chamber angle depth and reduce the intraocular pressure.

Antioxidative effects of cysteinyl leukotriene receptor antagonists montelukast and HAMI 3379 on ischemic injury in rat cortical neurons in vitro / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the antioxidative effects of two cysteinyl leukotriene receptors antagonists (CysLT1R and CysLT2R) montelukast and HAMI 3379 on ischemic injury of rat cortical neurons in vitro.</p><p><b>METHODS</b>Cultured rat cortical neurons were pretreated with CysLT1R antagonist montelukast and CysLT2R antagonist HAMI 3379, and then exposed to oxygen-glucose deprivation/recovery (OGD/R）or H2O2. Reactive oxygen species (ROS) mitochondrial membrane potential (MMP) depolarization, neuronal viability and lactate dehydrogenase (LDH) release were determined. Meanwhile, RNA interference was used to inhibit the expression of CysLT1R and CysLT2R，and the effects were observed.</p><p><b>RESULTS</b>ROS production in neurons was significantly increased after 1 h OGD, which reached the peak at 30 min and lasted for 1.5 h after recovery. Montelukast and HAMI 3379 at 0.01-1μmol/L moderately decreased OGD/R-induced ROS production (P<0.05). Montelukast mildly attenuated OGD/R-induced MMP depolarization (P<0.05)，but HAMI 3379 had no effect. H2O2 reduced neuronal viability and increased LDH release, namely inducing neuronal injury. Montelukast and HAMI 3379 at 0.1-1μmol/L moderately attenuated H2O2-induced neuronal injury (P<0.05). However, both CysLT1R siRNA and CysLT2R shRNA did not significantly affect the responses mentioned above.</p><p><b>CONCLUSION</b>In ischemic neuronal injury, montelukast and HAMI 3379 exert a moderate antioxidative effect, and this effect may be receptor-independent.</p>

Effect of histone deacetylase inhibitor NL101 on rat neurons / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the protective effect of histone deacetylase inhibitor NL101 on L-homocysteine (HCA)-induced toxicity in rat neurons, and the toxic effect on normal rat neurons.</p><p><b>METHODS</b>In the presence of NL101 at various concentrations, HCA (5 mmol/L)-induced changes in cell density, necrosis, and viability were determined in the mixed cultures of rat cortical cells and the primary cultures of rat neurons. The direct effect of NL101 on primary neurons was also observed in the absence of HCA. Histone deacetylase inhibitor suberoylanilide hydroxamic acid (SAHA) was used as the control. After the treatments, cell viability, the density, and morphology of neurons and glial cells, and cell necrosis were determined.</p><p><b>RESULTS</b>In the mixed cultures of cortical cells, NL101 had no effect on HCA (5 mmol/L)-induced cell number reduction at 0.001-10μmol/L; however, it significantly attenuated necrosis at 1-10 μmol/L, and increased neuronal number at 1 μmol/L. NL101 had no effect on the mixed cortical cells in the absence of HCA. In the primary neurons, NL101 reduced neuronal viability and mildly increased necrosis at 1-10 μmol/L in the absence of HCA, while it significantly attenuated HCA-induced neuronal viability reduction at 0.01-10 μmol/L and reduced neuronal necrosis at 1-10 μmol/L. The effects of NL101 were apparently similar to those of SAHA.</p><p><b>CONCLUSION</b>NL101 has protective effect on HCA-induced neuronal injury but it is neurotoxic at high concentrations, which is similar to the typical histone deacetylase inhibitor SAHA.</p>

Zileuton, a 5-lipoxygenase inhibitor, attenuates mouse microglial cell-mediated rotenone toxicity in PC12 cells / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To examine the effect of a selective inhibitor of 5-lipoxygenase (5-LOX) zileuton on microglia-mediated rotenone neurotoxicity.</p><p><b>METHODS</b>The supernatant from different concentrations of rotenone-stimulated mouse microglia BV2 cells was used as the conditioned media (CM) for PC12 cells. The viability of PC12 cells was determined by MTT assay and lactate dehydrogenase (LDH) release. Cell death was observed by LDH release and double fluorescence staining with Hoechst/propidiumiodide (PI). The effect of zileuton on microglia-mediated rotenone toxicity was evaluated by the above methods.</p><p><b>RESULTS</b>Rotenone at 1-10 nmol/L was nontoxic to PC12 cells directly. However, the CM from BV2 cells that were treated with rotenone (1-10 nmol/L) resulted in toxicity of PC12 cells. The BV2 CM which stimulated with rotenone (1-10 nmol/L) induced morphological changes, reduced cell viability, and increased LDH release and cell necrosis in PC12 cells. Pretreatment of BV2 cells with the 5-LOX inhibitor zileuton (0.01-1 μmol/L) protected PC12 cells from the microglia-mediated rotenone toxicity.</p><p><b>CONCLUSION</b>The 5-LOX inhibitor zileuton effectively attenuates microglia-mediated rotenone toxicity in PC12 cells. These results suggest that 5-LOX pathway may be involved in neuronal death induced by microglial inflammation.</p>

Prevalence and characterization of plasmid-mediated blaESBL with their genetic environment in Escherichia coli and Klebsiella pneumoniae in patients with pneumonia / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The extended spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) are the major pathogens causing pneumonia and have a significant impact on the clinical course. Limited data exist on molecular characterization of ESBL-producing E. coli and K. pneumoniae that cause pneumonia. The aim of this study was to investigate the comprehensive multilevel characteristics of E. coli and K. pneumoniae causing pneumonia in China for the first time.</p><p><b>METHODS</b>E. coli (17) and K. pneumoniae (21) isolates responsible for pneumonia were isolated from 1270 specimens collected in a prospective multi-center study in eight teaching hospitals in China from June to December in 2007. The susceptibilities, ESBL confirmation, sequence typing, blaCTX-M and blaSHV genes, their genetic environment and plasmid Inc/rep types were determined.</p><p><b>RESULTS</b>Sixteen E. coli (94.1%) and eleven K. pneumoniae (52.4%) isolates were ESBL producers. About 77.8% and 66.7% of them were resistance to ciprofloxacin and levofloxacin, and 100% were susceptible to imipenem. The most prevalent ESBL gene was CTX-M-14, followed by SHV-2, CTX-M-15, CTX-M-3, CTX-M-65, SHV-12, SHV-26 and SHV-28. SHV-1 and SHV-11 were also detected and coexisted with blaCTX-Ms in five strains, and three strains contained only SHV-1. All CTX-M-14 were detected ISEcp1 upstream and nine were found IS903 downstream and the majority of them (64.3%) were carried by IncF plasmids. All blaSHV were flanked by recF and deoR, located on IncF, IncN, IncX and IncH plasmids. Two SHV-2, one SHV-1 and the only SHV-28 were further preceded by IS26. Genes lacY and lacZ were detected at further upstream of two blaSHV-1. The K. pneumoniae carrying SHV-28 was susceptible to β-lactams, and no mutations or deletions in gene or promoter sequences were identified to account for susceptibility. Multilocus sequence typing experiments showed the ESBL-producing strains were genetically diverse.</p><p><b>CONCLUSIONS</b>The rate of occurrence of blaESBL in E. coli and K. pneumoniae causing pneumonia was high, and blaCTX-M-14 was dominant and probably mobilized by ISEcp1 mainly on IncF plasmids. Importantly, unexpressed blaESBL genes may occur in susceptible isolates and hence may have clinical implications.</p>

Interaction between continuous variables in logistic regression model / 中华流行病学杂志

Rothman argued that interaction estimated as departure from additivity better reflected the biological interaction. In a logistic regression model, the product term reflects the interaction as departure from multiplicativity. So far, literature on estimating interaction regarding an additive scale using logistic regression was only focusing on two dichotomous factors. The objective of the present report was to provide a method to examine the interaction as departure from additivity between two continuous variables or between one continuous variable and one categorical variable.We used data from a lung cancer case-control study among males in Hong Kong as an example to illustrate the bootstrap re-sampling method for calculating the corresponding confidence intervals.Free software R (Version 2.8.1) was used to estimate interaction on the additive scale.

Effects of pentoxifylline on Wnt/β-catenin signaling in mice chronically exposed to cigarette smoke / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Previous discovery that long-term administration of pentoxifylline (PTX) to mice chronically exposed to smoke led to the development of pulmonary fibrosis rather than emphysema initiated our curiosity on whether the Wnt/β-catenin pathway, a set of signaling proteins essential to organ development and lung morphogenesis in particular were activated in the pathogenesis of pulmonary fibrosis.</p><p><b>METHODS</b>Male BALB/c mice were randomized into four study groups: Group Sm, smoke exposure and taken regular forage; Group PTX, no smoke but taken PTX-rich forage; Group Sm + PTX, smoke exposure and taken PTX-rich forage; Group control: shamed smoke exposure and taken regular forage. Animals were sacrificed at day 120. Morphometry of the lung sections and the expressions of TGF-β(1), hydroxyproline, β-catenin, cyclin D1, T cell factor 1 (Tcf-1) and lymphoid enhancer factor 1 (Lef-1) mRNA, etc, in the lung homogenate or in situ were qualitatively or quantitatively analyzed.</p><p><b>RESULTS</b>As expected, smoke exposure along with PTX administration for 120 days, lungs of the mice progressed to be a fibrosis-like phenotype, with elevated fibrosis score (3.9 ± 1.1 vs. 1.7 ± 0.6 in Group Sm, P < 0.05). TGF-β(1) (pg/g) (1452.4 ± 465.7 vs. 818.9 ± 202.8 in Group Sm, P < 0.05) and hydroxyproline (mg/g) (5.6 ± 0.6, vs. 2.4 ± 0.1 in Group Sm, P < 0.05) were also consistently increased. The upregulation of β-catenin measured either by counting the cell with positive staining in microscopic field (17.4 ± 7.9 vs. 9.9 ± 2.9 in Group Sm, P < 0.05) or by estimation of the proportion of blue-stained area by Masson's trichrome (11.8 ± 5.6 vs. 4.7 ± 2.4 in Group Sm) in Group SM + PTX was much more noticeable as than those in Group Sm. The expression of β-catenin measured by positive cell counts was correlated to TGF-β(1) concentration in lung tissue (r = 0.758, P < 0.001). PTX per se caused neither fibrosis nor emphysema though expression of β-catenin and downstream gene cyclin D(1) may also be altered by this medication.</p><p><b>CONCLUSIONS</b>PTX mediated transformation of pulmonary emphysema into pulmonary fibrosis under chronic cigarette smoke exposure is associated with upregulation of β-catenin and elevation of TGF-β(1), implying that activation of Wnt/β-catenin signaling may be involved in the pathogenesis of pulmonary fibrosis.</p>

Impact of gender on in-hospital death in hospitalized patients with acute myocardial infarction / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate whether gender is an independent predictor of in-hospital death in hospitalized patients with acute myocardial infarction (AMI).</p><p><b>METHODS</b>This retrospective study compared baseline characteristics, therapeutic approaches and the occurrence rate of angina pectoris, reinfarction, heart failure and death during hospitalization between 1501 male and 635 female hospitalized patients with AMI. Multivariate logistic regression analysis was performed to identify risk factors predicting in-hospital death.</p><p><b>RESULTS</b>In-hospital death rate was significantly higher in female than male patients with AMI (11.7% vs. 6.3%, P < 0.01). Female patients with AMI were significantly older than male patients [(67.8 +/- 9.2) years vs. (61.1 +/- 11.9) years, P < 0.01] had a higher incidence of hypertension (52.1% vs. 41.1%, P < 0.01), diabetes mellitus (35.4% vs. 17.3%, P < 0.01), cardiac function > or = Killip class III (11.7% vs. 5.1%, P < 0.01) and TC > 4.68 mmol/L (71.3% vs. 55.0%, P < 0.01). Cigarette smoking, however, was more common in males than in females (69.4% vs. 15.7%, P < 0.01). Reperfusion therapy within the first 24 hours after symptom onset, beta-blockers and statins use during hospitalization were significantly fewer in females compared with males (22.2% vs. 31.5%, P < 0.01; 64.6% vs. 71.2%, P = 0.003; 43.1% vs. 48.0%, P = 0.041, respectively). An increased mortality was demonstrated in females during the hospitalization phase of AMI (11.7% vs. 6.3%, P < 0.01). The results of logistic regression demonstrated that age, diabetes mellitus, hypertension, Killip classification of cardiac function, administration of reperfusion therapy and beta receptor blockers use were significant predictors of in-hospital death in patients with AMI, with odds ratios being 1.06 (95% CI: 1.04 - 1.08), 1.96 (95% CI: 1.32 - 2.90), 1.80 (95% CI: 1.25 - 2.58), 2.86 (95% CI: 2.35 - 3.48), 0.44 (95% CI: 0.30 - 0.66) and 0.51 (95% CI: 0.36 - 0.74), respectively.</p><p><b>CONCLUSIONS</b>The in-hospital mortality of females is significantly higher than that of males in this patient cohort. Older age, higher risk factor rates, less reperfusion therapy and beta-blockers use contributed to the higher in-hospital mortality in female patients with AMI compared to males.</p>

Study on the interaction under logistic regression modeling / 中华流行病学杂志

When study on epidemiological causation is carried out,logistic regression has been commonly used to estimate the independent effects of risk factors.as well as to examine possible interactions among individual risk factor by adding one or more product terms to the regression model.In logistic or Cox's regression model.the regression coefficient of the product term estimates the interaction on a muhiplicative scale while statistical significance indicates the departure from multiplicativity.Rothman argues that when biologic interaction iS examined,we need to focus on interaction as departure from additivity rather than departure from multiplicativity.He presents three indices to measure interaction on an additive scale or departure from additivity.using logarithmic models such aS logistic or Cox's regression model.In this paper,we use data from a case-control study of female lung cancer in Hong Kong to calculate the regression coefficients and covariance matrix of logistie model in SPSS.We then introduce an Excel spreadsheet set up by Tomas Andersson to calculate the indices of interaction on an additive scale and the corresponding confidence intervals.The results can be used as reference by epidemiologists to assess the biologic interaction between factors.The proposed method is convenient and the Excel spreadsheet is available online for free.

Experimental therapeutic study for activated coagulation by hemorrhagic shock in rats / 中国实验血液学杂志

The study was aimed to investigate the changes of blood coagulation factors during hemorrhagic shock in rats and the effects of various of resuscitation fluids on expression of blood coagulation factors in rats with hemorrhagic shock and to clarify its possible mechanism. 50 SD rats were randomly divided into 5 groups: control, sham operation, shock, resuscitation 1 (infusion with Ringer's lactate) and resuscitation 2 (infusion with 6% VOLUVEN), 10 rats per group. The rats in resuscitation 1 and resuscitation 2 groups were subjected to hemorrhagic shock, after hemorrhage shock for 1 hour resuscitation was performed with Ringer's lactate and 6% VOLUVEN. After resuscitation for 2 hours the changes of t-PA, PAI-1, TF were measured. At the same time, the rats in shock and the sham operation groups were blooded out so as to test. The results showed that the levels of plasma t-PA, t-PA/PAI, TF in the shock and resuscitation 1 groups were significantly higher than that in control and sham operation groups (P<0.01). The levels of plasma t-PA, t-PA/PAI in resuscitation 1 group were higher than that in shock group (P<0.01), the levels of plasma t-PA, t-PA/PAI and TF in the resuscitation 2 group were significantly lower than that in shock and resuscitation 1 groups (P<0.01). It is concluded that hemorrhagic shock may trigger the coagulation cascade reaction, results in hyperfunctioning of fiberinolysis and activation of platelets and coagulation system, and so the coagulation factor is greatly consumed. Unbalance of coagulation system plays an important role in the progress of shock. Efficacy of resuscitation with 6% VOLUVEN plus Ringer's lactate may be better than Ringer's lactate alone in regulating blood coagulation after hemorrhagic shock in rats.

Impact of Chinese guidelines for management of patients with acute myocardial infarction on outcomes of hospitalized patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The first Chinese guidelines for the diagnosis and management of patients with acute myocardial infarction (AMI) were issued by the Cardiovascular Branch of the Chinese Medical Association, the Editorial Board of the Chinese Journal of Cardiology, and the Editorial Board of the Chinese Circulation Journal in December 2001. However, it is still unclear whether these guidelines have produced a major impact on clinical practice and patient outcomes. The purpose of this study was to evaluate the impact of these guidelines on the management and prognosis of Chinese patients with AMI.</p><p><b>METHODS</b>A retrospective study was carried out in patients with AMI who were admitted to Qilu Hospital of Shandong University from January 1994 to December 2004. Patients were divided into two groups: group A included patients admitted from January 1994 to December 2001, and group B comprised those admitted from January 2002 to December 2004. Therapeutic approaches and the occurrence rate of angina pectoris, reinfarction, heart failure and death during hospitalization were compared between two groups.</p><p><b>RESULTS</b>A total of 1783 patients including 1208 cases in group A and 575 cases in group B were enrolled in this study. No significant difference was found in baseline characteristics between group A and group B patients (all P > 0.05). There were more patients undergoing reperfusion therapy within the first 24 hours after symptom onset in group B than in group A (35.8% vs 21.7%, P < 0.001). Administration of beta-blockers, angiotensin-converting-enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), statins, and heparins were more commonly seen in group B than in group A (P < 0.001). There were no significant differences in the use of nitrates or antiplatelet drugs between groups A and B (98.8% vs. 97.9%, P = 0.172, and 97.4% vs 98.6%, P = 0.113, respectively). In-hospital angina pectoris, heart failure and death were all lower in group B than in group A (32.2% vs 41.2%, P < 0.001; 17.2% vs 26.2%, P < 0.001; and 6.4% vs 9.4%, P = 0.038, respectively). There was no significant difference in the rate of reinfarction between group A and B patients (2.2% vs 1.7%, P = 0.492).</p><p><b>CONCLUSIONS</b>Chinese guidelines for the management of patients with AMI issued in December 2001 resulted in changes in therapy that led to a significant improvement of in-hospital outcomes but not in the rate of reinfarction in patients with AMI.</p>

Effect of Chinese guidelines issued in 2001 on in-hospital management and prognosis of patients with acute myocardial infarction / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the effect of Chinese guidelines issued on December 2001 on in-hospital management and prognosis of patients with acute myocardial infarction.</p><p><b>METHODS</b>A retrospective study was carried out in patients hospitalized in our hospital with acute myocardial infarction from January 1994 to December 2004.</p><p><b>RESULTS</b>There were 1783 patients enrolled in our study. Reperfusion therapy was undergone in 21.7% of patients hospitalized between 1994 and 2001, and in 35.8% of patients hospitalized between 2002 and 2004 (P < 0.001). Beta-blockers, ACE inhibitors and/or angiotensin receptor blockers, lipid regulating agents and antithrombins were used more extensively between 2002 and 2004 than before (all P < 0.001). There were no significant differences in the usage of nitrates and antiplatelets before and after the guidelines was issued (98.8% vs 97.9%, P = 0.172; 97.4% vs 98.6%, P = 0.113 respectively). After the guidelines issued, the incidence of angina pectoris, heart failure and death in hospital were lower than before (32.2% vs 41.2%, P < 0.001; 17.2% vs 26.2%, P < 0.001; 6.4% vs 9.4%, P = 0.038).</p><p><b>CONCLUSIONS</b>Chinese guidelines issued on December 2001 have great effect on the management and prognosis of patients with acute myocardial infarction. After the guidelines was issued the management became more standardized and the incidence of in-hospital complications was lower than before.</p>